Just a year ago, poliovirus seemed on its last legs in Pakistan, one of its final strongholds. Polio cases were steadily falling, from 306 in 2014 to 54 in 2015, 20 in 2016, and, by last count, eight in 2017. Blood tests showed that, overall, immunity to the virus had never been higher, even among children aged 6 to 11 months, thanks to years of tireless vaccination campaigns. Surely, there were not enough susceptible kids to sustain transmission, and the virus would burn itself out within a year.

Unsettling new findings, however, show it is far from gone. In the most extensive effort in any country to scour the environment for traces of the virus, polio workers are finding it widely across Pakistan, in places they thought it had disappeared. They are wondering "just what the hell is going on" and how worried they should be, says epidemiologist Chris Maher of the World Health Organization (WHO) in Geneva, Switzerland, who runs polio operations in the eastern Mediterranean region. Does this mean the virus is more entrenched than anyone realized and is poised to resurge? Or is this how a virus behaves in its final days—persisting in the environment but not causing disease until it fades out?

[...] Along with Afghanistan and Nigeria, Pakistan is one of just three endemic countries—places where indigenous wild poliovirus has never been vanquished.

[...] Since the eradication effort began in 1988, the gold standard for detecting poliovirus has been surveillance for acute flaccid paralysis (AFP)—finding and testing every child with a sudden weakness or floppiness in the arms or legs. The yearly case count has been the benchmark for success: After 12 months without a polio case, WHO has historically removed a country from the endemic list.

Polio workers collect sewage samples, usually from open drainage ditches, and test them for virus. If the test is positive, that means someone in the catchment area is infected and actively excreting it. Pakistan now has 53 sampling sites, more than any other country. And at a time when cases are the lowest on record, 16% of samples from across the country are testing positive.

[...] One possible explanation for the disconnect is that AFP surveillance is missing cases. Maher doubts that the number is significant, but others suspect that too many children among the mobile populations, including the marginalized Pashtun minority, still aren't being vaccinated despite ramped up efforts to reach them. "I don't think polio is entrenched across Pakistan, but this last reservoir of 'people on the move' is sustaining the virus," says Steve Cochi, a polio expert at the U.S. Centers for Disease Control and Prevention in Atlanta.

[...] The program is not taking any chances. The response to each positive environmental test is now as aggressive as to a case of paralysis. And the program is hammering the virus with repeated vaccination campaigns throughout the "low season," between December and May, when cold weather makes it tougher for the virus to survive. Whether the strategy works will become clear later this year when the weather turns warm. But one thing is certain: The absence of cases is no longer enough to declare victory over polio. Going forward, a country will not be considered polio-free until 12 months have passed without a case—or a positive environmental sample.

Comment Below Threshold

The Truth(Score: -1, Spam) by Anonymous Coward on Friday January 12 2018, @12:39PM

‘What the hell is going on?’ You should be more concerned with what's going on in your bare, rancid asshole, which my fetid cock has deeply penetrated. Ah! I just breached your anal cervix. If I squirt my diseased cum in here and my cockpoles rape your fecal egg, you'll be pregnant in no time! Give birth to a feces baby, you sow!

What about people on self-contained septic systemsWhat about people on self-contained septic systems(Score: 3, Interesting) by JoeMerchant on Friday January 12 2018, @01:02PM
(8 children)

If the surveillance program is only watching open drainage ditches and other common sewage collection channels (53 points in a country of ~200 million, one sample site per 3.7 million people?!) how do they have any confidence at all of their coverage? Is the Pakistani infrastructure such that everybody's sewage ends up channeled together and in open ditches on such a scale?

Re:What about people on self-contained septic systRe:What about people on self-contained septic syst(Score: 5, Informative) by Zinho on Friday January 12 2018, @05:31PM
(7 children)

Good question, the answer to which is fairly well answered by news articles [tribune.com.pk] detailing what Aid agencies are concerned about in the region.

* For the most part, only rich people have toilets in their home at all, let alone connections to public sewers* For the most part, there are no public sewer systems, so the rich people with toilets are building self-contained septic systems* Many poor people in the region prefer public defecation for cultural reasons as well as financial - some believe it's better for their health* Poor hygiene culture is regional, not just country-specific; India has similar problems. [bbc.com]

If the government isn't building sewers, and rich people are either not getting sick or getting adequate medical care, then it makes sense for the disease eradication efforts to focus on the poor. In this case, open ditches are exactly the place to look for signs of infection.

On an unrelated note, mods be crazy today. Two redundant mods on the first two relevant article responses? How can the first non-spam post be redundant??? I'm glad we can do the post-and-moderate thing here, doing what I can to fix it.

Re:What about people on self-contained septic syst(Score: 2) by JoeMerchant on Friday January 12 2018, @09:44PM

No, no, actually we do know: Mad as a Hatter, Newton's madness - mercury will f-you up if you get too much in your system.

Still, polio vaccine is one of the great achievements of modern medicine - the 249th follow on, me too, I want my slice of that sweet vaccine profit pie lame excuse of a trumped up argument against a disease that's not all that out of hand? Personally, I think the vaccine show jumped the shark shortly after tetanus.

I remember one story about the Gates Foundation plowing money into vaccination against specific diseases when some local people were begging desperately for funding to deal with the sewage problem. The local pleas were being ignored because it was not what the money was earmarked for -- even though fixing the sewage problem would help prevent all sorts of diseases.

--The biggest challenge of the 21st century: the irony of technologies of abundance used by scarcity-minded people.

Re:What about people on self-contained septic systRe:What about people on self-contained septic syst(Score: 1) by khallow on Saturday January 13 2018, @04:09AM
(2 children)

I remember one story about the Gates Foundation plowing money into vaccination against specific diseases when some local people were begging desperately for funding to deal with the sewage problem. The local pleas were being ignored because it was not what the money was earmarked for -- even though fixing the sewage problem would help prevent all sorts of diseases.

Apparently, it is exclusively the Gates Foundation's responsibility to listen to people and fix the sewage problem. They don't have infinite resources to fix everything, so it shouldn't be surprising that they don't fix everything. There are numerous other parties slacking on this job, including several levels of government. Further, the Gates Foundation probably was funding one or more of those other glaring oversights with the immunizations.

Re:What about people on self-contained septic systRe:What about people on self-contained septic syst(Score: 0) by Anonymous Coward on Saturday January 13 2018, @04:26PM
(1 child)

It's the Gates Foundation's responsibility to research the situation and make the most effective use of the money. But vaccinations are high-tech, toilets low-tech and therefore not as sexy. If it was a government program doing this, you'd be apoplectic about how this was going down. So why give the Gates Foundation a pass?

Re:What about people on self-contained septic syst(Score: 1) by khallow on Monday January 15 2018, @02:57AM

It's the Gates Foundation's responsibility to research the situation and make the most effective use of the money.

No, it's not their responsibility. And what makes you think they made the wrong choice? Building sewers, toilets, and such is in reach of these communities. These are local problems easily solved at the local level. Immunizing large swaths of humanity is not.

But vaccinations are high-tech, toilets low-tech and therefore not as sexy.

And yet, vaccines aren't high-tech or sexy. That is an absurd thing to say. That's why the Gates Foundation ended up funding these things in the first place. Because a lot of others weren't.

From the article, it looks like a little of number 3, and a little of number 5. Disadvantaged transients both add to the number represented in each sample and have a high likelihood of developing symptoms without reporting. Hard people to help, but worth the effort to reach them.

PS - I gave you an "underrated" mod to back out the nonsense "redundant" you had before.

Polio cases were steadily falling, from 306 in 2014 to 54 in 2015, 20 in 2016, and, by last count, eight in 2017. Blood tests showed that, overall, immunity to the virus had never been higher, even among children aged 6 to 11 months

This requires a source so people can see how that data was generated. The quality of "Science" is dropping lower and lower to the point it offends the sensibilities of scholarly people.

Anway, polio is another case where a small percentage of infected people show the symptoms and many other causes apparently result in the exact same symptoms (similar to measles). What I would like to know is whether the cases of non-polio AFP have been increasing proportional to the drop in AFP blamed on polio.

Re:Publish in science without citing sources?Re:Publish in science without citing sources?(Score: 3, Informative) by FlyingSock on Friday January 12 2018, @02:11PM
(3 children)

While I agree that it would have been nice to have a direct link to the reports, just because a publication has 'science' in its name does not mean it is a scientific publication, ie. publishing scientific papers. In this case it appears the publication is merely reporting on science, hence the less stringent citation rules. This scholarly person is not offended by the missing link, as they know the difference between a newspaper and a scientific journal. So while science (no " necessary) has quite a few problems (procrastination being a big one ;) ) this is not really one of them.

just because a publication has 'science' in its name does not mean it is a scientific publication, ie. publishing scientific papers.

Sorry, but this response only shows you are entirely out of loop:

Science, also widely referred to as Science Magazine,[1] is the peer-reviewed academic journal of the American Association for the Advancement of Science[2][3] (AAAS) and one of the world's top academic journals.

Re:Publish in science without citing sources?Re:Publish in science without citing sources?(Score: 3, Informative) by FlyingSock on Friday January 12 2018, @04:04PM
(1 child)

just because a publication has 'science' in its name does not mean it is a scientific publication, ie. publishing scientific papers.

Sorry, but this response only shows you are entirely out of loop:

Science, also widely referred to as Science Magazine,[1] is the peer-reviewed academic journal of the American Association for the Advancement of Science[2][3] (AAAS) and one of the world's top academic journals.

Eh, fair enough, no need to apologise. Science is of course a well known scientific publication. Given the style of the article I assumed it was from a different publication with a similar name. This does not negate my point however, that this is a news article as opposed to a scientific one. The article we are discussing here is not from the 'research' section of science but from the 'news' section. A good example for the difference between the two is the mars ice cliffs articles in the current issue. One in the news section [1] and one in the research section [2]. The first is written in a similar way as the polio article, the latter as a scientific article (including a reference list, sources and I assume peer reviewed).

How is it clear that the data is coming from this site?

All the people cited in the article are from the WHO anti polio campaign, hence the data can be found in the WHO reports on polio. The reports I linked are hosted on WHO's own site, this site [3] was simply the first hit when I googled the WHO's anti polio campaign.

Can you point to exactly where you found the data?

The 54 cases for 2015 and 20 cases for 2016 can be found in table 1 in the respective year sections under the heading "Confirmed WPV cases" in the report "Surveillance systems to track progress towards polio eradication worldwide, 2015–2016" [4].The 306 cases in 2014 can be found in "Polio surveillance: tracking progress towards eradication, worldwide, 2014–2015" [5] also table 1.Both [4] and [5] are linked from the site I originally linked [3], where I found them.

But I really would expect a scholarly person to be able to find these reports themselves, as do the editors of science apparently.

Re:Publish in science without citing sources?(Score: 0) by Anonymous Coward on Friday January 12 2018, @04:38PM

It is funny that you think it is "making fun of [me]" to cite your sources correctly (not link to a page with dozens of pdfs) when responding to a claim that the quality of scholarship is dropping. Also, yes I realized that was their "news" section, plenty of news sites not associated with (and leveraging the prestige of) scientific journals manage to cite their sources. It really isn't hard.

Anyway, thanks. It is nice that they have total AFP cases. We see this:

Year p-AFP Total AFP2014 306 53692015 54 58142016 20 7797

So the actual problem (AFP) actually appears to be getting worse from this data (of course we need population covered to really compare). No one cares about polio except that it causes AFP, and it seems to be a minor cause at that (~1%)...

It'd be a pain in this format but I'd like to see this comparison for all the countries. Does total AFP always rise as polio-caused AFP drops? There should just be a csv with this data somewhere.

When the USA tracked down Bin Laden, they used a fake vaccination program in order to collect blood samples for testing. Since then many people in Pakistan are still distrustful against vaccination programs. A lot of Red Cross volunteers still get killed there because of this distrust, for example Six Red Cross workers killed [theguardian.com].

It's bad in many ways. On many sides. Some vaccines are very important. But autism has become an epidemic. It has gotten totally out of control. Pakistan, after getting more than 33 billion dollars in aid over the last 15 years, have given us nothing but lies & deceit, thinking of our leaders as fools. They give safe haven to the terrorists we hunt in Afghanistan, with little help from that shithole country. But President Obama and the Deep State did a terrible thing. They were just as deceitful.

Re:No, that is fake news.(Score: 0) by Anonymous Coward on Friday January 12 2018, @10:29PM

I'm not saying this was a case where sterilization was done, but the US has been known to sterilize the population in the past. Specifically Native Americans and the mentally handicapped, probably others too.

Re:some other organisam hosts the virusRe:some other organisam hosts the virus(Score: 5, Informative) by Joe on Friday January 12 2018, @03:05PM
(1 child)

There is no other animal known to be infected by poliovirus. Absence of evidence isn't necessarily evidence of absence, but scientists have looked really hard and understand a lot about the virus from both an epidemiology and a virology standpoint.

Bacteria do not have the machinery necessary to support entry or replication of the virus, but polio can persist in sewage for months all on its own.

Second:There are two types of polio vaccines: the weakened "live" vaccine and the regular strain that is "killed".

The "live" vaccine is taken orally, which allows for replication of the weakened virus in the intestines and subsequent shedding of the weakened virus into the sewage system and persist for months. The weakened virus strain is able to mutate (reversion) back to the regular strain and cause disease (vaccine associated poliomyelitis) at some small frequency. Because the immune system is exposed to the virus in the intestines, future immune responses are targeted there and prevent any future viral replication - once a patient stops shedding the vaccine strain, they will not be able to spread anymore (heard immunity).

The "killed" vaccine is injected, so the immune system mounts a general response that is not targeted to the intestines. This means that patients will be protected from disease, but any "live" poliovirus that they are exposed to can still replicate in their intestines and be shed into sewage. This means that heard immunity is not as effective and the virus will spread (without disease in an adequately vaccinated population). This is why you can detect poliovirus in the sewage from countries that haven't had a disease case ("polio free") in years.

In conclusion, "epidemiologist Chris Maher" should remember that just because he doesn't know "what the hell is going on" doesn't mean that scientists haven't already known about this for more than twenty years.